A substantial number of individuals who undergo cognitive processing therapy (CPT) for posttraumatic stress disorder (PTSD) drop out before receiving a full course of treatment. Therapeutic alliance, defined as the working relationship between the therapist and client, is a dynamic process within therapy that may change over time. Research suggests that therapeutic alliance is associated with dropout in various treatments. However, no studies have yet examined the association between therapeutic alliance and dropout in CPT, and few studies have examined therapeutic alliance longitudinally over the course of treatment. Examining alliance in CPT through different methods may increase clinicians’ understanding of how to tailor interventions to prevent treatment dropout. The present study examined the association between therapeutic alliance and treatment dropout among 169 participants in a randomized implementation effectiveness trial. In total, 33.1% of clients dropped out over the course of CPT, and nearly half of these individuals dropped out during the first six sessions. Continuous-time survival analysis results indicated that mean ratings of alliance significantly predicted treatment dropout, Wald χ²(1, N = 167) = 4.08, Exp(β) = .64, p = .043, whereas initial alliance, late alliance, and change in alliance over treatment did not. These findings suggest that overall therapeutic alliance is an important predictor of dropout from CPT.

中文翻译：

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治疗联盟对创伤后应激障碍认知加工治疗中辍学的影响

大量接受创伤后应激障碍 (PTSD) 认知处理疗法 (CPT) 的人在接受完整疗程之前就退出了。治疗联盟，定义为治疗师和客户之间的工作关系，是治疗中的一个动态过程，可能会随着时间的推移而变化。研究表明，治疗联盟与各种治疗中的辍学有关。然而，还没有研究检查治疗联盟和 CPT 中途退出之间的关联，并且很少有研究在治疗过程中纵向检查治疗联盟。通过不同的方法检查 CPT 中的联盟可能会增加临床医生对如何调整干预措施以防止治疗脱落的理解。本研究在一项随机实施有效性试验中检查了 169 名参与者的治疗联盟与治疗退出之间的关联。总共有 33.1% 的客户在 CPT 过程中退出，其中近一半的人在前六节中退出。连续时间生存分析结果表明，联盟的平均评分显着预测治疗退出，Wald χ² (1, N = 167) = 4.08, Exp(β) = .64, p = .043，而初始联盟、后期联盟和治疗联盟的变化则没有。这些发现表明，整体治疗联盟是 CPT 退出的重要预测指标。